| National Provider Identifier [NPI]: | 1366599227 |
| Last Name Of The Provider | MAGNUSSEN |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2050 KENNY RD |
| Street Address 2 Of The Provider | PAVILLION SUITE 3100 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432213502 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 197 |
| Number Of Medicare Beneficiaries | 44 |
| Total Submitted Charge Amount | 48528.2 |
| Total Medicare Allowed Amount | 16061.51 |
| Total Medicare Payment Amount | 12193.81 |
| Total Medicare Standardized Payment Amount | 12467.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 86 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 4013.2 |
| Total Drug Medicare AllowedAmount | 1217.17 |
| Total Drug Medicare PaymentAmount | 948.59 |
| Total Drug Medicare Standardized Payment Amount | 948.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 111 |
| Number Of Medicare Beneficiaries With Medical Services | 44 |
| Total Medical Submitted Charge Amount | 44515 |
| Total Medical Medicare Allowed Amount | 14844.34 |
| Total Medical Medicare Payment Amount | 11245.22 |
| Total Medical Medicare Standardized Payment Amount | 11519.04 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 27 |
| Number Of Male Beneficiaries | 17 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.1906 |